Genetic counselling: Predicting patient outcomes

Abstract

With the rapid development of genetic testing, the demand for genetic counselling is increasing. Yet there is little known about what makes for effective or efficient genetic counselling. The aim of the current study is to determine the main factors influencing outcomes of genetic consultations. One hundred and thirty one routine consultations conducted in a regional genetics centre were audiotaped, transcribed and coded. The main predictors of outcome tested were pre-interview patient and counsellor expectations; pre-interview patient concerns; length of consultations; counsellor directiveness; and the extent to which social and emotional issues are addressed in the consultation. The main outcomes were the patient's view of the extent to which their expectations were met, their satisfaction with information provided, and concern about the problem they were referred with.

Although there were six significant correlations between the process of consultation and outcome variables, multivariate analyses revealed no significant predictors of any of the outcomes. Using multiple regression analyses, small amounts of variance in patient outcomes were predicted by patient and counsellor variables assessed before the consultation, but none was predicted by any of the process measures made of the consultation. Various explanations are considered to explain the lack of influence of process variables upon outcomes. One possible explanation for these findings is that the consultation has a minimal effect upon patient outcomes. Alternatively, the study, in design or analysis, was not sufficiently sensitive to detect the influential aspects of the consultation.     

The relationship of confabulation to the memory,intelligence, suggestibility and personality of prison inmates

This study investigates the relationship of confabulation to memory, intelligence, suggestibility and personality, as measured by the Eysenck Personality Questionnaire and the Gough Socialisation Scale. The subjects were 255 Icelandic prison inmates. Confabulation was measured from the memory narrative of the Gudjonsson Suggestibility Scale (GSS 1). The two components of confabulation—distortions and fabrications—were scored and analysed separately. Distortions and fabrications correlated poorly with each other. Furthermore, the confabulation scores correlated very poorly with the other psychological variables. The only positive correlations were a positive relationship with GSS Shift and a negative relationship with intelligence.     

Self‐Directing Religious Coping: A Deistic God,Abandoning God,or No God at All?

Self-directing religious coping has been correlated with both positive and negative outcome variables in previous research. The purpose of this study was to explore the potential meaning behind these mixed findings by clarifying the nature of the self-directing religious coping construct. A new set of subscales was constructed that operationalized different aspects of the construct. This scale, the original Religious Problem Solving Scale, and mental-health measures were given to 262 undergraduate students at a moderate-sized midwestern university. Two factors were identified with the revised self-directing measure: a deistic and supportive but nonintervening God factor and an abandoning God factor. The Abandoning God Subscale was more highly correlated with the original Self-Directing Scale than was the deistic God measure. The Deistic and Supportive God Subscale was correlated with both positive and negative mental-health outcomes, whereas the abandoning God measure consistently related to poorer outcomes.     

The relationship of selected consultant/teacher characteristics to consultation outcomes

This study examined the relationship of teacher life position, teacher dogmatism, perceived consultant facilitativeness, years of teacher teaching experience and number of consultations per year to the consultation outcomes of teacher satisfaction, teacher strength, and problem resolution. A number of significant findings resulted, with the consultant's perceived facilitativeness being the main predictor of the desirable consultation outcomes. These results are consistent with some earlier findings. Some results that are inconsistent with other studies also are discussed.     

Religious Orientation, Mature Faith, and Psychological Distress: Elements of Positive and Negative Associations

There are substantial data exploring the link between religiousness and health, yet there is little consensus regarding the nature of the relationship between religiousness domains and mental health. The purpose of this study was to identify the types of mental health outcomes associated with religiousness domains. Participants included 251 ( M = 19.02; range = 17–25) young adults who completed self-report measures of religiousness (Intrinsic, Extrinsic, and Quest Orientations, Faith Maturity Scale), and psychological distress subscales (SCL-90-R). We identified significant relationships between each of the religiousness measures and the SCL-90-R subscales and analyzed the relative contributions of each of the religiousness measures in predicting psychological distress with hierarchical multiple regression. The Faith Maturity Scale was a particularly robust predictor of positive and negative psychological adjustment. The specific pathways by which religiousness influences mental health outcomes remain to be elaborated in future research.     

The Relationship Between Attitudinal and Behavioral Measures of Sex Preference

This study examined the relationship between an attitudal and a behavioral measure of sex preference for offspring. In addition to looking at the relationship between these measures, their relationship to other variables was also investigated. Pregnant women and their spouses (N = 56) responded to a questionnaire measure of sex preference, a behavioral measure of sex preference, Bern's Sex Role Inventory, and the Attitudes Towards Women Scale. The behavioral and questionnaire measures of sex preference were significantly related, indicating that in the area of preferred sex of firstborn children, attitudinal measures appear to be highly related to behavioral measures. Contrary to prediction, androgynous and nonandrogyn-ous persons did not differ significantly on preferred sex of child. However, persons with a more positive attitude toward women's movement ideology showed significantly less male preference than persons with less positive attitudes toward women's movement ideology.     

Relationship factors as predictors of causal attributions about sexual experiences

This study investigated the relation between general relationship satisfaction and sexual satisfaction by seeking to identify which aspects of one's relationship would predict attributions made about sexual experiences. Subjects were 233 male and female graduate and undergraduate students who were asked to rate the extent to which self, partner, situational, and relationship factors were causes for sexually satisfying and unsatisfying experiences. General relationship satisfaction, phase of relationship involvement, depth of sexual involvement, importance of sexual satisfaction to overall relationship contentment, sexual history, and gender were variables entered into multiple regression analysis to identify the best fit model predicting causal attributions to each dimension. Findings revealed that relationship satisfaction and gender appeared to contribute to a reliable best fit model which predicted attributions to the sexual relationship for satisfying sexual outcomes. Sexual history was a strong predictor variable, occurring in the best fit models for all but two attribution dimensions; other relationship variables were not strong contributors to predictive models. Finally, the inclusion of an interpersonal attributional dimension, the relationship, appeared to be highly relevant when persons identified explanations for their sexual experience outcomes. Implications of the findings and suggestions for further research are discussed.     

Gender and ethnic differences in the relationship between body esteem and self-esteem.

Gender and ethnic differences in the relationship between body esteem and self-esteem were examined to assess the degree to which these variables change in relation to each other over time. Difference scores (between Time 1 and Time 2, 1 week apart) were obtained using the Self-Esteem Scale (M. Rosenberg, 1979) and the Body Esteem Scale (S. L. Franzoi & S. A. Shields, 1984) for 163 White women, 140 White men, 55 Black women, and 37 Black men. The results indicated that the correlation of the difference scores was stronger for the group of White women than for the other 3 groups, suggesting that changes in self-esteem parallel changes in body esteem more for White women than for White men, Black men, and Black women. The findings are discussed in relation to the prevalence of bulimia nervosa among White women.     

Group CBT for Externalizing Disorders in Urban Schools: Effect of Training Strategy on Treatment Fidelity and Child Outcomes

Public schools are an ideal setting for the delivery of mental health services to children. Unfortunately, services provided in schools, and more so in urban schools, have been found to lead to little or no significant clinical improvements. Studies with urban school children seldom report on the effects of clinician training on treatment fidelity and child outcomes. This study examines the differential effects of two levels of school-based counselor training: training workshop with basic consultation (C) vs. training workshop plus enhanced consultation (C +) on treatment fidelity and child outcomes. Fourteen school staff members (counselors) were randomly assigned to C or C +. Counselors implemented a group cognitive behavioral therapy protocol (Coping Power Program, CPP) for children with or at risk for externalizing behavior disorders. Independent coders coded each CPP session for content and process fidelity. Changes in outcomes from pre to post were assessed via a parent psychiatric interview and interviewer-rated severity of illness and global impairment. Counselors in C + delivered CPP with significantly higher levels of content and process fidelity compared to counselors in C. Both C and C + resulted in significant improvement in interviewer-rated impairment; the conditions did not differ from each other with regard to impairment. Groups did not differ with regard to pre- to- posttreatment changes in diagnostic severity level. School-based behavioral health staff in urban schools are able to implement interventions with fidelity and clinical effectiveness when provided with ongoing consultation. Enhanced consultation resulted in higher fidelity. Enhanced consultation did not result in better student outcomes compared to basic consultation. Implications for resource allocation decisions with staff training in EBP are discussed.     

Comparative relationships of the Wechsler Adult Intelligence Scale—Revised (WAIS-R) and the Wechsler Adult Intelligence Scale (WAIS) to the Wechsler Memory Scale (WMS)

This study investigated whether the Wechsler Adult Intelligence Scale — Revised (WAIS-R) and Wechsler Adult Intelligence Scale (WAIS) demonstrate similar patterns of relationship with the Wechsler Memory Scale (WMS). Sixty VA patients were administered the WAIS-R and WMS and 60 completed the WAIS and WMS. The groups were comparable in terms of demographic variables. Pearson correlations were computed between the subtest and IQ scores from the intelligence scales and the scores from the WMS for each group. Comparison of the resulting correlations for the WAIS-R group with those of the WAIS subjects demonstrated only four significant differences, indicating that the WAIS-R and WAIS variables covary in a similar manner with the WMS scores. Following factor analysis of the test data for both groups, coefficients of congruence indicated a high degree of similarity between the two factor solutions. Essentially the same relationships emerged between intelligence variables and the WMS regardless of which scale was administered.     

The Investment Model Scale: Measuring commitment level,satisfaction level,quality of alternatives,and investment size

Three studies evaluated the reliability and validity of the Investment Model Scale, an instrument designed to measure four constructs, including commitment level and three bases of dependence–satisfaction level, quality of alternatives, and investment size. In all three studies, reliability analyses revealed good internal consistency among items designed to measure each construct. Also, principal components analyses performed on scale items revealed evidence of four factors, with items designed to measure each construct loading on independent factors. Studies 2 and 3 examined associations of model variables with instruments measuring diverse qualities of relationships and assorted personal dispositions. As anticipated, Investment Model variables were moderately associated with other measures reflecting superior couple functioning (e.g., dyadic adjustment, trust level, inclusion of other in the self), and were essentially unrelated to measures assessing personal dispositions (e.g., need for cognition, self-esteem). In addition, Study 3 demonstrated that earlier measures of Investment Model variables predicted later levels of dyadic adjustment and later relationship status (persisted vs. ended). It is hoped that the existence of a reliable and valid Investment Model Scale will promote further research regarding commitment and interdependence in ongoing close relationships.     

Meta-analysis for single-case consultation outcomes: Applications to research and practice

The application of meta-analysis holds much appeal for single-case consultation outcome research. We review a meta-analytic method for using within-study treatment effect sizes in reporting consultation outcomes. The strengths and limitations of traditional group design meta-analysis are examined. Various methods for analyzing single-case outcomes are discussed briefly, followed by an examination of the use of meta-analysis in single-case reviews across independent studies. Within-study meta-analytic results are presented that were derived from treatments implemented in consultations in natural settings. To conclude the article, an illustration is offered of a single-case data analysis display that incorporates meta-analytic results along with other indices of treatment outcome. Recommendations are provided for using meta-analytic methods to evaluate outcomes of single-case consultation treatment.     

EPQ correlates of the personality deviance scale

New patients at a psychiatric day hospital were asked to complete a set of questionnaires, including the Eysenck Personality Questionnaire, and the Personality Deviance Scale of Bedford and Foulds. This paper reports on the resulting correlations between the variables measured by these two inventories. The findings broadly replicate those of Bedford and Foulds with the Eysenck Personality Inventory and the Personality Deviance Scale. The Neuroticism scale of the EPQ was found to correlate with all of the PDS scales, and particularly highly with intropunitiveness. As regards the Psychoticism Scale of the EPQ, this was found to correlate highly with extrapunitiveness, but not with intropunitiveness or dominance. It is concluded that there appears to be some relationship between P and this hostility measure of extrapunitiveness, a finding somewhat in contradiction to recent conclusions by Forbes based on his study of a normal sample.     

Influence of adolescent maternal characteristics on infant development

The present study proposed that several adolescent maternal variables would be associated with infant development. Using a sample of 71 adolescent mother‐infant dyads, the study examined the relative influences of the adolescent's level of separation‐individuation (Separation‐Individuation Process Inventory), feelings of attachment towards the infant (Maternal Postnatal Attachment Scale), and feelings of anxiety regarding separation (Maternal Separation Anxiety Scale) on infant mental and motor development (Bayley Scales of Infant Development, 2nd ed.). As it was assumed that the adolescent's perceptions of being parented would provide the foundation for each of these independent variables, this factor was also included (Parental Bonding Instrument). In the current sample, adolescent separation‐individuation was the only maternal psychological variable to uniquely predict infant development, but only on the mental scale. Present findings highlight the importance of considering critical developmental processes of adolescence when exploring cognitive functioning and other outcomes in infants of adolescents. A number of possible mechanisms for the influence of separation‐individuation are considered in the discussion.     

Confirmatory factor analysis of the Machiavellian Personality Scale

According to Christie and Geis (1970), Machiavellianism predisposes one to self-interested behavior, manipulation, and deceit often at the expense of others. The measurement of Machiavellianism began with the Mach IV (Christie & Geis, 1970), which has long suffered from an indeterminant factor structure and poor reliability. Dahling, Whitaker, and Levy (2009) developed the Machiavellian Personality Scale (MPS) to address these shortcomings. In the current examination of the MPS, a four-factor structure is supported with confirmatory factor analysis, but the relationships in a full structural equation model between the four subscales and the criterion of empathy is problematic in that some MPS subscales are negative, some positive, and some unrelated to empathy. Additionally, reliability issues arose with the MPS as have historically occurred with the Mach IV. The four subscales of the MPS appear to act as suppressors of each other, further complicating the predictive relationship between Machiavellianism and other variables.     

Intimate partner cohesion and military unit cohesion: Different types of interpersonal relationships each uniquely predict soldier well-being

Although research on military populations has found that measures of personal well-being are correlated with both intimate partner cohesion and military unit cohesion, it is not clear how these correlations should be interpreted. Based on Relationship Regulation Theory, it was expected that each type of interpersonal relationship would have independent effects, that each would uniquely predict outcomes, and that effects would remain significant after controlling for person-level traits and experiences, such as trait resilience and exposure to combat. A sample of 273 active-duty military personnel completed self-report measures of cohesion in two types of interpersonal relationships (intimate relationships and military unit relationships), two control variables (trait resilience and combat exposure), and three outcome variables (well-being, negative emotionality, and trauma-related stress). Results indicated that cohesion in the two types of relationships were minimally related to each other, but both correlated with outcome variables. Effects for each type of interpersonal relationship remained significant after controlling for the other type and controlling for trait resilience and combat exposure. The results suggest that the effects of interpersonal cohesion are best understood as reflecting experiences in specific types of relationships rather than general characteristics of people in those relationships.     

Clinical Consultation as a Family Intervention in Residential Treatment: Exploring What Impacts Outcomes

The Relational Re-enactment Systems Approach to Treatment model is an approach to residential treatment that embraces the need for family involvement through clinical consultation. Clinical consultation is a systems-oriented family intervention that embodies the model’s principles regarding therapeutic alliance and working through ambivalence. Families engage with treatment providers and other collaterals in an ongoing process of developing goals, creating a shared understanding of the youth, and working toward discharge. The current study explored youth characteristics and outcomes. Additionally, the investigation included comparisons between youth with and without the involvement of the Department of Children and Family Services in terms of length of stay, involvement in consultation, and sustained outcomes. Finally, therapists who work with youth and their families discussed their understanding of what differentiated successful and unsuccessful cases.     

Locus of Control and Academic Engagement: Mediating Role of Religious Commitment

Earlier studies have shown that locus of control is related to academic processes and outcomes. However, the nature of the relationship between locus of control, religious commitment, and academic engagement is unclear. This study examined the mediating role of religious commitment in linking locus of control with academic engagement, as well as the engagement dimensions - vigour, dedication, and absorption. Four hundred and eight university students completed the Locus of Control Behaviour Scale, Religious Commitment Inventory and Utrecht Work Engagement Scale – Student version. Locus of control was found to be positively related to the outcome variables. Intrapersonal religious commitment was positively related to the outcome variables. Interpersonal religious commitment did not have a significant relationship with vigour and absorption but it was significantly related to dedication and the total scores of academic engagement. Structural equation modelling analyses indicated significant paths from locus of control to academic engagement through both intrapersonal religious commitment and interpersonal religious commitment. Locus of control and religious commitment are suggested to be relevant in programmes and interventions to enhance academic engagement.     

An Investigation of Islamic Well-Being and Mental Health

The overall aim of this study was to develop the Islamic Well-Being Scale and examine the relationship between mental health and Islamic well-being. In this study, four sub-studies were performed to create the one-factor Islamic Well-Being Scale, perform a confirmatory factor analysis and validate the Islamic Well-Being Scale, differentially predict ill-being and well-being outcomes using the Islamic Well-Being Scale, and compare individuals with different Islamic belief levels using the Islamic Well-Being Scale. In total, 170 adults, 209 adults, 216 theological faculty students and 152 undergraduate educational faculty students participated in each sub-study. Several scales related to well-being and ill-being were used in this study. The Islamic Well-Being Scale was found to be valid and reliable. Islamic well-being was related to certain indicators of well-being and ill-being.

     

The validity of the Crites model of career maturity

To test the validity of the Crites model of career maturity, career maturity and noncareer maturity measures were administered to 312 ninth graders and to 200 technical college students. Scores on all measures were intercorrelated and factor analyzed. The results show that, as predicted, most of the Career Choice Competencies have more in common with each other than they have with Career Choice Attitudes; Career Choice Competencies are fairly highly positively related to each other; Career Choice Attitudes and Career Choice Competencies have more in common with each other in grade 9 than they do in the post-secondary grades; and there is a relationship between career maturity and sex and race of ninth graders and technical college students. The results do not support the hypothesized multidimensional structure of the Crites model or the hypothesis that variables in the Crites model have more in common with each other than they have with noncareer maturity variables. Discussion includes several possible explanations for failure to support the Crites model, and suggestions for further research.